The Intersections of Ethnicity, Nativity Status and Socioeconomic Position in Relation to Periodontal Status: A Cross-Sectional Study in London, England.

Syeda Ammara Shaharyar,Eduardo Bernabé,Elsa Karina Delgado-Angulo

doi:10.3390/ijerph181910519

Abstract

The role of migration as a social determinant of periodontitis has been overlooked. Intersectionality theory could help understand how immigration status interacts with other social determinants of health to engender inequalities in periodontitis. The objective of the present study was to evaluate whether ethnicity, nativity status and socioeconomic position intersect to structure social inequalities in periodontal status. Data from 1936 adults in a deprived and multi-ethnic area of London were analysed. The numbers of teeth with probing depth and clinical attachment loss were determined from clinical examinations. A matrix with 51 intersectional strata, defined according to ethnicity, nativity status and education, was created. A cross-classified multilevel analysis, with participants clustered within intersectional social strata, was performed to assess the extent to which individual differences in periodontal measures were at the intersectional strata level. A complex pattern of social inequalities in periodontal status was found, which was characterised by high heterogeneity between strata and outcome-specificity. The variance partition coefficient of the simple intersectional model, which conflated additive and interaction effects, indicated that 3–5% of the observed variation in periodontal measures was due to between-stratum differences. Moreover, the percentual change in variance from the simple intersectional to the intersectional interaction model indicated that 73–74% of the stratum-level variance in periodontal measures was attributed to the additive effects of ethnicity, nativity status and education. This study found modest evidence of intersectionality among ethnicity, nativity status and education in relation to periodontal status.

Highlights

Periodontitis is a plaque-induced, inflammatory disease that progressively affects the tissues supporting the teeth [1]
This study used cross-sectional data from the East London Oral Health Inequalities (ELOHI) study, a mixed-methods project exploring the connections among area deprivation, ethnicity and oral health of families in Outer North East London (ONEL, which includes the boroughs of Barking and Dagenham, Redbridge and Waltham Forest)
The PCV from the intersectional interaction model indicated that 74% of the between-stratum variance was due to the additive effects of ethnicity, nativity status, education and confounders

Summary

Introduction

Periodontitis is a plaque-induced, inflammatory disease that progressively affects the tissues supporting the teeth [1]. It is a common disease, affecting 10% of people globally [2]. It can affect function and aesthetics and lead to tooth loss [3]. The presentation of periodontitis is shaped by social circumstances, with greater prevalence and severity of disease among worse-off individuals [4,5]. There is evidence of ethnic inequalities in periodontal disease, not all ethnic minorities are at a disadvantage compared to the White population [6,7,8,9,10]. Ethnic inequalities are not accounted for by demographic characteristics, socioeconomic position (SEP) or behaviours [7,10]

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Discussion

Conclusion